Response:

We thank Drs Kidambi, Terdiman, and Lee1 for their interest and their thoughtful comments related to our study.2 Our proposed adenoma and polyp management efficiency indices are not meant to supplant but rather to complement current quality metrics while also providing a platform to measure colonoscopy efficiency during fellowship training. To this point, the negative withdrawal time is not truly an efficiency metric because it sets a minimum withdrawal time threshold for an adequate quality examination.

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